Retavase

Reteplase


Chiesi Usa, Inc.
Human Prescription Drug
NDC 10122-141
Retavase also known as Reteplase is a human prescription drug labeled by 'Chiesi Usa, Inc.'. National Drug Code (NDC) number for Retavase is 10122-141. This drug is available in dosage form of Kit. The names of the active, medicinal ingredients in Retavase drug includes . The currest status of Retavase drug is Active.

Drug Information:

Drug NDC: 10122-141
The labeler code and product code segments of the National Drug Code number, separated by a hyphen. Asterisks are no longer used or included within the product code segment to indicate certain configurations of the NDC.
Proprietary Name: Retavase
Also known as the trade name. It is the name of the product chosen by the labeler.
Product Type: Human Prescription Drug
Indicates the type of product, such as Human Prescription Drug or Human OTC Drug. This data element corresponds to the “Document Type” of the SPL submission for the listing.
Non Proprietary Name: Reteplase
Also known as the generic name, this is usually the active ingredient(s) of the product.
Labeler Name: Chiesi Usa, Inc.
Name of Company corresponding to the labeler code segment of the ProductNDC.
Dosage Form: Kit
The translation of the DosageForm Code submitted by the firm. There is no standard, but values may include terms like `tablet` or `solution for injection`.The complete list of codes and translations can be found www.fda.gov/edrls under Structured Product Labeling Resources.
Status: Active
FDA does not review and approve unfinished products. Therefore, all products in this file are considered unapproved.
Substance Name:
This is the active ingredient list. Each ingredient name is the preferred term of the UNII code submitted.
Route Details:
The translation of the Route Code submitted by the firm, indicating route of administration. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.

Marketing Information:

An openfda section: An annotation with additional product identifiers, such as NUII and UPC, of the drug product, if available.
Marketing Category: BLA
Product types are broken down into several potential Marketing Categories, such as New Drug Application (NDA), Abbreviated New Drug Application (ANDA), BLA, OTC Monograph, or Unapproved Drug. One and only one Marketing Category may be chosen for a product, not all marketing categories are available to all product types. Currently, only final marketed product categories are included. The complete list of codes and translations can be found at www.fda.gov/edrls under Structured Product Labeling Resources.
Marketing Start Date: 30 Oct, 1996
This is the date that the labeler indicates was the start of its marketing of the drug product.
Marketing End Date: 16 Jan, 2026
This is the date the product will no longer be available on the market. If a product is no longer being manufactured, in most cases, the FDA recommends firms use the expiration date of the last lot produced as the EndMarketingDate, to reflect the potential for drug product to remain available after manufacturing has ceased. Products that are the subject of ongoing manufacturing will not ordinarily have any EndMarketingDate. Products with a value in the EndMarketingDate will be removed from the NDC Directory when the EndMarketingDate is reached.
Application Number: BLA103786
This corresponds to the NDA, ANDA, or BLA number reported by the labeler for products which have the corresponding Marketing Category designated. If the designated Marketing Category is OTC Monograph Final or OTC Monograph Not Final, then the Application number will be the CFR citation corresponding to the appropriate Monograph (e.g. “part 341”). For unapproved drugs, this field will be null.
Listing Expiration Date: 31 Dec, 2023
This is the date when the listing record will expire if not updated or certified by the firm.

OpenFDA Information:

An openfda section: An annotation with additional product identifiers, such as NUII and UPC, of the drug product, if available.
Manufacturer Name:Chiesi USA, Inc.
Name of manufacturer or company that makes this drug product, corresponding to the labeler code segment of the NDC.
RxCUI:763138
763141
The RxNorm Concept Unique Identifier. RxCUI is a unique number that describes a semantic concept about the drug product, including its ingredients, strength, and dose forms.
Original Packager:Yes
Whether or not the drug has been repackaged for distribution.
UPC:0310122143012
UPC stands for Universal Product Code.
UNII:
Unique Ingredient Identifier, which is a non-proprietary, free, unique, unambiguous, non-semantic, alphanumeric identifier based on a substance’s molecular structure and/or descriptive information.

Packaging Information:

Package NDCDescriptionMarketing Start DateMarketing End DateSample Available
10122-141-021 KIT in 1 BOX (10122-141-02) * 10 mL in 1 VIAL, SINGLE-USE * 10 mL in 1 SYRINGE (10122-142-01)30 Oct, 1996N/ANo
Package NDC number, known as the NDC, identifies the labeler, product, and trade package size. The first segment, the labeler code, is assigned by the FDA. Description tells the size and type of packaging in sentence form. Multilevel packages will have the descriptions concatenated together.

Product Elements:

Retavase reteplase retavase reteplase reteplase reteplase dibasic potassium phosphate phosphoric acid polysorbate 80 sucrose tranexamic acid sterile water water water retavase reteplase retavase reteplase reteplase reteplase dibasic potassium phosphate phosphoric acid polysorbate 80 sucrose tranexamic acid sterile water water

Indications and Usage:

1 indications and usage retavase is indicated for use in acute st-elevation myocardial infarction (stemi) to reduce the risk of death and heart failure. limitation of use: the risk of stroke may outweigh the benefit produced by thrombolytic therapy in patients whose stemi puts them at low risk for death or heart failure. retavase is a tissue plasminogen activator (tpa) indicated for treatment of acute st-elevation myocardial infarction (stemi) to reduce the risk of death and heart failure. ( 1 ) limitation of use: the risk of stroke may outweigh the benefit produced by thrombolytic therapy in patients whose stemi puts them at low risk for death or heart failure. ( 1 )

Warnings and Cautions:

5 warnings and precautions increases the risk of bleeding. avoid intramuscular injections. ( 5.1 ) hypersensitivity ( 5.2 ) cholesterol embolism ( 5.3 ) 5.1 bleeding retavase can cause significant and sometimes fatal bleeding. avoid intramuscular injections and other trauma to a patient administered retavase. minimize venipunctures. avoid puncturing noncompressible veins, such as the internal jugular and subclavian. if an arterial puncture is necessary, use an upper extremity vessel that is accessible to manual compression, apply pressure for at least 30 minutes, and monitor the puncture site closely. as fibrin is lysed during retavase therapy, bleeding from recent puncture sites or other recent trauma may occur. should serious bleeding (not controllable by local pressure) occur, terminate concomitant anticoagulant therapy. withhold the second retavase dose if serious bleeding occurs before it is administered. 5.2 hypersensitivity reactions hypersensitivity reactions have been reported
with retavase administration. signs and symptoms observed included rash, pruritis, erythema, glossal (tongue) edema, hypotension and respiratory distress. if an anaphylactoid reaction occurs, withhold the second dose of retavase and initiate appropriate therapy. 5.3 cholesterol embolization cholesterol embolism has been reported in patients treated with thrombolytic agents. cholesterol embolism may present with livedo reticularis, “purple toe” syndrome, acute renal failure, gangrenous digits, hypertension, pancreatitis, myocardial infarction, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction, and rhabdomyolysis and can be fatal. it is also associated with invasive vascular procedures (e.g., cardiac catheterization, angiography, vascular surgery) and/or anticoagulant therapy. 5.4 drug/laboratory test interactions coagulation tests and measures of fibrinolytic activity are unreliable during retavase therapy unless specific precautions are taken to prevent in vitro artifacts. when present in blood at pharmacologic concentrations, retavase remains active under in vitro conditions, which can result in degradation of fibrinogen in blood samples removed for analysis.

5.1 bleeding retavase can cause significant and sometimes fatal bleeding. avoid intramuscular injections and other trauma to a patient administered retavase. minimize venipunctures. avoid puncturing noncompressible veins, such as the internal jugular and subclavian. if an arterial puncture is necessary, use an upper extremity vessel that is accessible to manual compression, apply pressure for at least 30 minutes, and monitor the puncture site closely. as fibrin is lysed during retavase therapy, bleeding from recent puncture sites or other recent trauma may occur. should serious bleeding (not controllable by local pressure) occur, terminate concomitant anticoagulant therapy. withhold the second retavase dose if serious bleeding occurs before it is administered.

5.2 hypersensitivity reactions hypersensitivity reactions have been reported with retavase administration. signs and symptoms observed included rash, pruritis, erythema, glossal (tongue) edema, hypotension and respiratory distress. if an anaphylactoid reaction occurs, withhold the second dose of retavase and initiate appropriate therapy.

5.3 cholesterol embolization cholesterol embolism has been reported in patients treated with thrombolytic agents. cholesterol embolism may present with livedo reticularis, “purple toe” syndrome, acute renal failure, gangrenous digits, hypertension, pancreatitis, myocardial infarction, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction, and rhabdomyolysis and can be fatal. it is also associated with invasive vascular procedures (e.g., cardiac catheterization, angiography, vascular surgery) and/or anticoagulant therapy.

5.4 drug/laboratory test interactions coagulation tests and measures of fibrinolytic activity are unreliable during retavase therapy unless specific precautions are taken to prevent in vitro artifacts. when present in blood at pharmacologic concentrations, retavase remains active under in vitro conditions, which can result in degradation of fibrinogen in blood samples removed for analysis.

Dosage and Administration:

2 dosage and administration two 10 unit intravenous injections, each administered over 2 minutes, 30 minutes apart. ( 2.1 ) no other medication should be injected or infused simultaneously via the same intravenous line or added to the injection solution. ( 2.1 ) 2.1 dosing information and administration as soon as possible after the onset of stemi, administer 10 units intravenously over 2 minutes. administer a second dose of 10 units 30 minutes after the first dose. 2.2 reconstitution reconstitute retavase immediately before administration. reconstitute retavase only with the supplied sterile water for injection. slight foaming upon reconstitution may occur; if necessary allow the vial to stand undisturbed for several minutes to allow dissipation of any large bubbles. prior to administration, inspect the product for particulate matter and discoloration. use aseptic technique throughout. step 1: open the package containing the reconstitution spike. remove the protective cap from the lue
r lock port of the reconstitution spike and remove the protective cap on the end of the sterile 10 ml pre-filled syringe. remove the protective flip-cap from one vial of retavase. step 2: clean the rubber closure with an alcohol wipe (not contained within kit). step 3: connect the sterile pre-filled syringe to the reconstitution spike. step 4: remove the protective cap from the spike end of the reconstitution spike and firmly insert the spike into the vial of retavase. step 5: connect the syringe plunger to the sterile 10 ml pre-filled syringe by screwing the plunger into the rubber stopper. step 6: transfer the 10 ml of sterile water for injection through the reconstitution spike into the vial of retavase. step 7: with the reconstitution spike and empty pre-filled syringe still attached to the vial, swirl the vial gently until the contents are fully dissolved, may take up to 2 minutes. do not shake . upon reconstitution, the solution should be clear and colorless. discard if particulate matter or discoloration is observed. the resulting solution concentration is 1 unit/ml and delivers 10 ml (10 units reteplase). step 8: disconnect the empty pre-filled syringe from the reconstitution spike and connect the plastic, graduated syringe to the reconstitution spike that is still attached to the vial. step 9: withdraw 10 ml of retavase reconstituted solution into the graduated syringe. a small amount of solution will remain in the vial due to overfill. detach the graduated syringe from the reconstitution spike. 2.3 heparin incompatibility heparin and retavase are incompatible. do not administer retavase through an intravenous line containing heparin.

2.1 dosing information and administration as soon as possible after the onset of stemi, administer 10 units intravenously over 2 minutes. administer a second dose of 10 units 30 minutes after the first dose.

2.2 reconstitution reconstitute retavase immediately before administration. reconstitute retavase only with the supplied sterile water for injection. slight foaming upon reconstitution may occur; if necessary allow the vial to stand undisturbed for several minutes to allow dissipation of any large bubbles. prior to administration, inspect the product for particulate matter and discoloration. use aseptic technique throughout. step 1: open the package containing the reconstitution spike. remove the protective cap from the luer lock port of the reconstitution spike and remove the protective cap on the end of the sterile 10 ml pre-filled syringe. remove the protective flip-cap from one vial of retavase. step 2: clean the rubber closure with an alcohol wipe (not contained within kit). step 3: connect the sterile pre-filled syringe to the reconstitution spike. step 4: remove the protective cap from the spike end of the reconstitution spike and firmly insert the spike into the vial of retavas
e. step 5: connect the syringe plunger to the sterile 10 ml pre-filled syringe by screwing the plunger into the rubber stopper. step 6: transfer the 10 ml of sterile water for injection through the reconstitution spike into the vial of retavase. step 7: with the reconstitution spike and empty pre-filled syringe still attached to the vial, swirl the vial gently until the contents are fully dissolved, may take up to 2 minutes. do not shake . upon reconstitution, the solution should be clear and colorless. discard if particulate matter or discoloration is observed. the resulting solution concentration is 1 unit/ml and delivers 10 ml (10 units reteplase). step 8: disconnect the empty pre-filled syringe from the reconstitution spike and connect the plastic, graduated syringe to the reconstitution spike that is still attached to the vial. step 9: withdraw 10 ml of retavase reconstituted solution into the graduated syringe. a small amount of solution will remain in the vial due to overfill. detach the graduated syringe from the reconstitution spike.

2.3 heparin incompatibility heparin and retavase are incompatible. do not administer retavase through an intravenous line containing heparin.

Dosage Forms and Strength:

3 dosage forms and strengths for injection: 10 units as a lyophilized powder in single-use vials for reconstitution co-packaged with sterile water for injection, usp in 10 ml prefilled syringe. for injection: 10 units as a lyophilized powder in single-use vials for reconstitution co-packaged with sterile water for injection, usp in 10 ml prefilled syringe. ( 3 )

Contraindications:

4 contraindications because thrombolytic therapy increases the risk of bleeding, retavase is contraindicated in the following situations: active internal bleeding recent stroke intracranial or intraspinal surgery or serious head trauma within 3 months intracranial conditions that increase the risk of bleeding (e.g. neoplasms, arteriovenous malformation, or aneurysms) bleeding diathesis current severe uncontrolled hypertension do not use in patients with: active internal bleeding ( 4 ) recent stroke ( 4 ) recent intracranial or intraspinal surgery or serious head trauma ( 4 ) intracranial neoplasm, arteriovenous malformation, or aneurysm ( 4 ) known bleeding diathesis ( 4 ) severe uncontrolled hypertension ( 4 )

Adverse Reactions:

6 adverse reactions the following adverse reactions are discussed in greater detail in the other sections of the label: bleeding [see contraindications ( 4 ) and warnings and precautions ( 5.1 )] hypersensitivity reactions [see warnings and precautions ( 5.2 )] cholesterol embolization [see warnings and precautions ( 5.3 )] the most common adverse reaction (>5%) is bleeding. ( 6.1 ) to report suspected adverse reactions, contact chiesi usa, inc. at 1-888-661-9260 or fda at 1-800-fda-1088 or www.fda.gov/medwatch . 6.1 clinical trials experience because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. bleeding the most frequent adverse reaction associated with retavase is bleeding. intracranial hemorrhage [see clinical studies ( 14 )] in the inject clinical trial, the overall rate of
in-hospital, intracranial hemorrhage was 0.8%. the risk for intracranial hemorrhage is increased in patients with advanced age (2.2% among patients >70 years old) or with elevated blood pressure (2.4% among patients with systolic blood pressure >160 mmhg). other types of hemorrhage the incidence of other types of bleeding events in clinical studies of retavase varied depending upon the use of arterial catheterization or other invasive procedures and whether the study was performed in europe or the usa. the overall incidence of any bleeding event in patients treated with retavase in clinical studies (n = 3,805) was 21.1%. the rates for bleeding events, regardless of severity, for the 10 + 10 unit retavase regimen from controlled clinical studies are summarized in table 1. table 1: retavase hemorrhage rates bleeding site inject rapid 1 and rapid 2 europe n = 2,965 usa n = 210 europe n =113 injection site includes the arterial catheterization site (all patients in the rapid studies underwent arterial catheterization). 4.6% 48.6% 19.5% gastrointestinal 2.5% 9.0% 1.8% genitourinary 1.6% 9.5% 0.9% anemia, site unknown 2.6% 1.4% 0.9% in these studies the severity and sites of bleeding events were similar for retavase and the comparison thrombolytic agents. allergic reactions among the 2,965 patients receiving retavase in the inject trial, serious allergic reactions were noted in 3 patients, with one patient experiencing dyspnea and hypotension. among the 9,938 patients that received retavase in a postmarketing clinical study, 8 patients experienced allergic and/or anaphylactoid reactions. signs and symptoms observed included rash, pruritis, erythema, glossal (tongue) edema, hypotension, and respiratory distress.

6.1 clinical trials experience because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. bleeding the most frequent adverse reaction associated with retavase is bleeding. intracranial hemorrhage [see clinical studies ( 14 )] in the inject clinical trial, the overall rate of in-hospital, intracranial hemorrhage was 0.8%. the risk for intracranial hemorrhage is increased in patients with advanced age (2.2% among patients >70 years old) or with elevated blood pressure (2.4% among patients with systolic blood pressure >160 mmhg). other types of hemorrhage the incidence of other types of bleeding events in clinical studies of retavase varied depending upon the use of arterial catheterization or other invasive procedures and whether the study was performed in europe or the usa. the overall
incidence of any bleeding event in patients treated with retavase in clinical studies (n = 3,805) was 21.1%. the rates for bleeding events, regardless of severity, for the 10 + 10 unit retavase regimen from controlled clinical studies are summarized in table 1. table 1: retavase hemorrhage rates bleeding site inject rapid 1 and rapid 2 europe n = 2,965 usa n = 210 europe n =113 injection site includes the arterial catheterization site (all patients in the rapid studies underwent arterial catheterization). 4.6% 48.6% 19.5% gastrointestinal 2.5% 9.0% 1.8% genitourinary 1.6% 9.5% 0.9% anemia, site unknown 2.6% 1.4% 0.9% in these studies the severity and sites of bleeding events were similar for retavase and the comparison thrombolytic agents. allergic reactions among the 2,965 patients receiving retavase in the inject trial, serious allergic reactions were noted in 3 patients, with one patient experiencing dyspnea and hypotension. among the 9,938 patients that received retavase in a postmarketing clinical study, 8 patients experienced allergic and/or anaphylactoid reactions. signs and symptoms observed included rash, pruritis, erythema, glossal (tongue) edema, hypotension, and respiratory distress.

Adverse Reactions Table:

Bleeding SiteINJECTRAPID 1 and RAPID 2
Europe N = 2,965USA N = 210Europe N =113
Injection Siteincludes the arterial catheterization site (all patients in the RAPID studies underwent arterial catheterization). 4.6%48.6%19.5%
Gastrointestinal2.5%9.0%1.8%
Genitourinary1.6%9.5%0.9%
Anemia, site unknown2.6%1.4%0.9%

Bleeding SiteINJECTRAPID 1 and RAPID 2
Europe N = 2,965USA N = 210Europe N =113
Injection Siteincludes the arterial catheterization site (all patients in the RAPID studies underwent arterial catheterization). 4.6%48.6%19.5%
Gastrointestinal2.5%9.0%1.8%
Genitourinary1.6%9.5%0.9%
Anemia, site unknown2.6%1.4%0.9%

Use in Specific Population:

8 use in specific populations pediatric use: safety and effectiveness have not been established. ( 8.4 ) 8.1 pregnancy risk summary limited published data with retavase use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes. in animal reproduction studies, reteplase administered to pregnant rabbits resulted in hemorrhaging in the genital tract, leading to abortions in mid-gestation in doses 3 times the human dose; however, there was no evidence of fetal anomalies in rats at doses up to 15 times the human dose. the estimated background risk of major birth defects and miscarriage for the indicated population(s) are unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. clinical considerations maternal adverse reactions the mos
t common complication of thrombolytic therapy is bleeding and pregnancy may increase this risk. data animal data reteplase was administered to pregnant rabbits in doses 3 times the human dose (0.86 units/kg) resulting in hemorrhaging in the genital tract, leading to abortions in mid-gestation. in animal developmental studies in rats at reteplase doses up to 15 times the human dose (4.31 units/kg), there was no evidence of fetal anomalies. 8.2 lactation risk summary there are no data on the presence of reteplase in either human or animal milk, the effects on the breastfed infant, or the effects on milk production. retevase has not been studied in nursing mothers. 8.4 pediatric use safety and effectiveness of retavase in pediatric patients have not been established.

Use in Pregnancy:

8.1 pregnancy risk summary limited published data with retavase use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes. in animal reproduction studies, reteplase administered to pregnant rabbits resulted in hemorrhaging in the genital tract, leading to abortions in mid-gestation in doses 3 times the human dose; however, there was no evidence of fetal anomalies in rats at doses up to 15 times the human dose. the estimated background risk of major birth defects and miscarriage for the indicated population(s) are unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. clinical considerations maternal adverse reactions the most common complication of thrombolytic therapy is bleeding and pregnancy may increase this risk. data anim
al data reteplase was administered to pregnant rabbits in doses 3 times the human dose (0.86 units/kg) resulting in hemorrhaging in the genital tract, leading to abortions in mid-gestation. in animal developmental studies in rats at reteplase doses up to 15 times the human dose (4.31 units/kg), there was no evidence of fetal anomalies.

Pediatric Use:

8.4 pediatric use safety and effectiveness of retavase in pediatric patients have not been established.

Description:

11 description reteplase is a non-glycosylated deletion mutein of tissue plasminogen activator (tpa), containing the kringle 2 and the protease domains of human tpa. reteplase contains 355 of the 527 amino acids of native tpa (amino acids 1-3 and 176-527). reteplase is produced by recombinant dna technology in e. coli. the protein is isolated as inactive inclusion bodies from e. coli, converted into its active form by an in vitro folding process and purified by chromatographic separation. the molecular weight of reteplase is 39,571 daltons. potency is expressed in units (u) using a reference standard which is specific for retavase and is not comparable with units used for other thrombolytic agents. retavase (reteplase) for injection is a sterile, white, lyophilized powder for intravenous injection after reconstitution with sterile water for injection, usp (without preservatives). following reconstitution with 10 ml of sterile water for injection, the resulting concentration is 1 unit/ml to allow for delivery of 10 ml (10 units reteplase). the ph is 6.0 ± 0.3. retavase is supplied with overfill to ensure sufficient drug for administration of each 10 unit injection. each single-use vial delivers: reteplase 10 units dipotassium hydrogen phosphate 131 mg phosphoric acid 49.3 mg polysorbate 80 5 mg sucrose 350 mg tranexamic acid 8 mg

Clinical Pharmacology:

12 clinical pharmacology 12.1 mechanism of action retavase is a recombinant plasminogen activator which catalyzes the cleavage of endogenous plasminogen to generate plasmin. plasmin in turn degrades the fibrin matrix of the thrombus, thereby exerting its thrombolytic action. 12.2 pharmacodynamics in a controlled trial, 36 of 56 patients treated for myocardial infarction had a decrease in fibrinogen levels to below 100 mg/dl by 2 hours following the administration of retavase as two intravenous injections (10 + 10 unit) in which 10 units was followed 30 minutes later by a second dose of 10 units. the mean fibrinogen level returned to the baseline value by 48 hours. 12.3 pharmacokinetics based on the measurement of thrombolytic activity, retavase is cleared from plasma at a rate of 250-450 ml/min, with an effective half-life of 13-16 minutes. retavase is cleared primarily by the liver and kidney.

Mechanism of Action:

12.1 mechanism of action retavase is a recombinant plasminogen activator which catalyzes the cleavage of endogenous plasminogen to generate plasmin. plasmin in turn degrades the fibrin matrix of the thrombus, thereby exerting its thrombolytic action.

Pharmacodynamics:

12.2 pharmacodynamics in a controlled trial, 36 of 56 patients treated for myocardial infarction had a decrease in fibrinogen levels to below 100 mg/dl by 2 hours following the administration of retavase as two intravenous injections (10 + 10 unit) in which 10 units was followed 30 minutes later by a second dose of 10 units. the mean fibrinogen level returned to the baseline value by 48 hours.

Pharmacokinetics:

12.3 pharmacokinetics based on the measurement of thrombolytic activity, retavase is cleared from plasma at a rate of 250-450 ml/min, with an effective half-life of 13-16 minutes. retavase is cleared primarily by the liver and kidney.

Nonclinical Toxicology:

13 nonclinical toxicology 13.1 carcinogenesis and mutagenesis long-term studies in animals have not been performed to evaluate the carcinogenic potential of retavase. studies to determine mutagenicity, chromosomal aberrations, gene mutations, and micronuclei induction were negative at all concentrations tested.

Carcinogenesis and Mutagenesis and Impairment of Fertility:

13.1 carcinogenesis and mutagenesis long-term studies in animals have not been performed to evaluate the carcinogenic potential of retavase. studies to determine mutagenicity, chromosomal aberrations, gene mutations, and micronuclei induction were negative at all concentrations tested.

Clinical Studies:

14 clinical studies retavase was evaluated in three controlled clinical studies comparing retavase to other thrombolytic agents. in all three studies, patients were treated with aspirin (initial doses of 160 mg to 350 mg and subsequent doses of 75 mg to 350 mg) and heparin (a 5,000 unit iv bolus prior to the administration of retavase or control, followed by a 1000 unit/hour continuous iv infusion for at least 24 hours). the inject study compared retavase to streptokinase on mortality rates at 35 days following acute st-elevation myocardial infarction (stemi). inject was a double-blind study in which 6,010 patients with no more than 12 hours of chest pain consistent with coronary ischemia and either st segment elevation or bundle branch block on ecg were randomized 1:1 to retavase (10 + 10 unit) or streptokinase (1.5 million units over 60 minutes). patients with cerebrovascular or other bleeding risks or with systolic blood pressure >200 mm hg or diastolic blood pressure >100 mm hg wer
e excluded from enrollment. the study was designed to determine whether the effect of retavase on survival was noninferior to that of streptokinase by ruling out with 95% confidence that 35-day mortality among retavase patients was no more than 1% higher than among streptokinase patients. the results of the primary endpoint (mortality at 35 days), 6-month mortality, and selected other in-hospital endpoints are shown in table 2. table 2: inject study: selected results endpoint retavase n = 2,965 streptokinase n = 2,971 retavase-streptokinase ∆ (95% ci) 35-day mortality kaplan-meier estimates 8.9% 9.4% -0.5 (-2.0, 0.9) 6-month mortality 11.0% 12.1% -1.1 (-2.7, 0.6) cardiogenic shock 4.6% 5.8% -1.2 (-2.4, -0.1) heart failure in-hospital 24.8% 28.1% -3.3 (-5.6, -1.1) any stroke in-hospital 1.4% 1.1% 0.3 (-0.3, 0.8) intracranial hemorrhage in-hospital 0.8% 0.4% 0.4 (0.0, 0.8) more patients treated with retavase experienced hemorrhagic strokes than did patients treated with streptokinase. an exploratory analysis indicated that the incidence of intracranial hemorrhage was higher among older patients or those with elevated blood pressure. the other two studies (rapid 1 and rapid 2) compared coronary artery patency of retavase to two regimens of alteplase in patients with stemi. in rapid 1 patients within 6 hours of the onset of symptoms were randomized to open-label administration of one of three regimens of retavase (doses of 10 + 10 unit, 15 unit, or 10 + 5 unit) or to alteplase (100 mg over 3 hours). in rapid 2 patients within 12 hours of the onset of symptoms were randomized to open-label administration of either retavase (10 + 10 unit) or alteplase (100 mg over 1.5 hours). the primary endpoint for both studies was patency of the infarct-related artery 90 minutes after initiation of therapy. interpretation of coronary angiograms was blinded. a higher percentage of subjects administered retevase had complete flow (timi grade 3) and partial or complete flow (timi grades 2 or 3) compared to both regimens of alteplase. the relationship between coronary artery patency and clinical efficacy has not been established. in both clinical trials the re-occlusion rates were similar for retavase and alteplase. table 3: rapid 1 and rapid 2 studies: angiographic results 90 minute patency rates rapid 2 rapid 1 p values represent one of multiple dose comparisons. retavase (10 +10 unit) n = 157 alteplase (100 mg over 1.5 hours) n = 146 p - value retavase (10 +10 unit) n = 142 alteplase (100 mg over 3 hours) n = 145 p - value timi 2 or 3 83% 73% 0.03 85% 77% 0.08 timi 3 60% 45% 0.01 63% 49% 0.02

How Supplied:

16 how supplied/storage and handling retavase (reteplase) for injection is supplied as a sterile, preservative-free, lyophilized powder in 10 unit vials without a vacuum, in the following packaging configurations: retavase kit (ndc 10122-141-02): 2 single-use retavase vials 10 units, 2 single-use prefilled syringes for reconstitution (10 ml sterile water for injection, usp), 2 syringe plungers, 2 sterile 10 ml graduated syringes, 2 sterile reconstitution spikes, 1 quick reference guide and 1 package insert. retavase half-kit (ndc 10122-143-01): 1 single-use retavase vial 10 units, 1 single-use prefilled syringe for reconstitution (10 ml sterile water for injection, usp), 1 syringe plunger, 1 sterile 10 ml graduated syringe, 1 sterile reconstitution spike, 1 quick reference guide and 1 package insert. storage: store retavase at 2°c to 25°c (36°f to 77°f). the box should remain sealed until use to protect the lyophilisate from exposure to light. manufactured by: chiesi usa, i
nc. cary, nc 27518 u.s. license no. 2150 retavase® manufactured at patheon italia, s.p.a., monza, italy 20900. to report an adverse event, record the lot number and call medical information at 1-888-661-9260. retavase® is a registered trademark of chiesi usa, inc. the trademarks streptase®, activase®, and actilyse® referenced herein are the property of their respective owners and are not affiliated with, connected to, or sponsored by chiesi usa, inc. ctr-001-0422-03-spl

Package Label Principal Display Panel:

Retavase full kit retavase full kit

Retavase half kit retavase half kit


Comments/ Reviews:

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